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The usual dose of Reyataz when boosted is 300mg a day (2 x 150mg capsules). Some people need 400mg to get a decent drug level.

You can use Reyataz unboosted, particularly if this is your first combo and/or you have no PI resistance. But, the durability of the drug seems significantly better for people using it boosted compared to unboosted. The Norvir booster levels out the Reyataz concentration and stops it falling away at the end of the dose (avoiding resistance).

If you have spot on adherence, then you can try unboosted. It's nice to be off Norvir, really. If you do, pester your doc for some therapeutic drug level monitoring. Therapeutic drug level monitoring will tell you if you're getting enough Reyataz all the time for it to keep your virus supressed. This should be easy to access in mainland Europe.

You are right though, it's not licenced unboosted in Europe, but then it's not approved for first-line combo either and I went on it as my firt-time PI.

Ritonavir is a weird drug, for one, as an HIV med in its own right, the quantity you need to take for it to be therapeutic is massive n well toxic.

But, it is a miracle booster drug, and makes other Pis work longer, harder, better, even at low doses.

It is a powerful inhibitor of the liver metabolic pathway P450, which means it affects how the body deals with many, many drugs, including HIV meds, but also others like benzodiazepines, some antibiotics, recreation drugs etc. This is its strength and weakness.

Badwise, it is probably the part of Pi regimes (well most) that cause the blood fat rises, and therefore less is better. This is really an individual thing, this, most people are fine, I mean really ok, on 100mg, many on 200mg, but some suffer just looking at it. I guess there is a questionmark over long-term use and liver health, but that ain't unique to ritonavir.

Trouble is, nothing is quite as good n simple as ritonavir at boosting other drugs. People have been looking, though.

The other thing, which needs more study, is that one dose of ritonavir creates a boosting effect for more than 1 day, 48 hrs perhaps or more. However, adherence wise every other day is hard and the proof-of-concept work hasn't been followed up with a large-scale real-life trial. Someone should really do a study on this, say Monday ritonavir+ Friday ritonavir, and see if it works.

The boosting doses are pragmatic and random, there's never been a really fine study on how much ritonavir you need to get the boosting effect, prob cos Abbott only make it in 100mg doses.